Objective: To describe the disease characteristics of osteonecrosis of the femoral head (ONFH) in patients with systemic lupus erythematosus (SLE) who experiencing prolonged glucocorticoid (GC) exposure.
Methods: Between January 2016 and June 2019, 449 SLE patients meeting the criteria were recruited from multiple centers. Hip MRI examinations were performed during screening and regular follow-up to determine the occurrence of ONFH. The cohort was divided into ONFH and non-ONFH groups, and the differences in demographic baseline characteristics, general clinical characteristics, GC medication information, combined medication, and hip clinical features were compared and comprehensively described.
Results: The age at SLE diagnosis was 29.8 (23.2, 40.9) years, with 93.1% (418 cases) being female. The duration of GC exposure was 5.3 (2.0, 10.5) years, and the cumulative incidence of SLE-ONFH was 9.1%. Significant differences ( P<0.05) between ONFH and non-ONFH groups were observed in the following clinical characteristics: ① Demographic baseline characteristics: ONFH group had a higher proportion of patients with body mass index (BMI)<20 kg/m 2 compared to non-ONFH group. ② General clinical characteristics: ONFH group showed a higher proportion of patients with cutaneous and renal manifestations, positive antiphospholipid antibodies (aPLs) and anticardiolipin antibodies, severe SLE patients [baseline SLE Disease Activity Index 2000 (SLEDAI-2K) score ≥15], and secondary hypertension. Fasting blood glucose in ONFH group was also higher. ③ GC medication information: ONFH group had higher initial intravenous GC exposure rates, duration, cumulative doses, higher cumulative GC doses in the first month and the first 3 months, higher average daily doses in the first 3 months, and higher proportions of average daily doses ≥15.0 mg/d and ≥30.0 mg/d, as well as higher full-course average daily doses and proportion of full-course daily doses ≥30.0 mg/d compared to non-ONFH group. ④ Combined medications: ONFH group had a significantly higher rate of antiplatelet drug use than non-ONFH group. ⑤ Hip clinical features: ONFH group had a higher proportion of hip discomfort or pain and a higher incidence of hip joint effusion before MRI screening than non-ONFH group.
Conclusion: The incidence of ONFH after GC exposure in China's SLE population remains high (9.1%), with short-term (first 3 months), medium-to-high dose (average daily dose ≥15 mg/d) GC being closely associated with ONFH. Severe SLE, low BMI, certain clinical phenotypes, positive aPLs, and secondary hypertension may also be related to ONFH.
目的: 描述系统性红斑狼疮（systemic lupus erythematosus，SLE）患者长期糖皮质激素（glucocorticoid，GC）暴露发生股骨头坏死（osteonecrosis of the femoral head，ONFH）的患病特征。.
方法: 2016年1月—2019年6月，由多中心招募符合标准的449例SLE患者作为研究对象，分别在筛选入组及定期随访观察时进行髋关节MRI检查，判断是否出现ONFH。将队列人群分为ONFH组和非ONFH组，比较两组之间人口学基线特征、一般临床特征、GC用药信息、合并用药情况及髋部临床特征的差异，作综合性描述。.
结果: 患者确诊SLE时年龄为29.8（23.2，40.9）岁，女性占93.1%（418例），GC暴露时间为5.3（2.0，10.5）年，SLE-ONFH累计新发病率为9.1%。ONFH和非ONFH两组以下临床特征差异有统计学意义（ P<0.05）：① 人口学基线特征：ONFH组身体质量指数（body mass index，BMI）<20 kg/m 2患者比例大于非ONFH组。② 一般临床特征：ONFH组皮肤黏膜型和肾型患者比例，空腹血糖、任一抗磷脂抗体（antiphospholipid antibodies，aPLs）阳性及抗心磷脂抗体阳性比例，重症SLE患者 ［基线SLE活动指数2000（SLEDAI-2K）评分≥15分］比例，以及继发动脉性高血压比例均明显高于非ONFH组。③ GC用药信息：ONFH组较非ONFH组有更高的初始阶段静脉GC暴露比例、持续时间、累计剂量，更高的首月及前3个月GC累计剂量、前3个月日均剂量及前3个月日均剂量≥15.0 mg/d、≥30.0 mg/d比例，以及更高的全程日均剂量和全程日均剂量≥30.0 mg/d比例。④ 合并用药情况：ONFH组抗血小板药应用率显著高于非ONFH组。⑤ 髋部临床特征：ONFH组MRI筛查前已出现髋部不适或疼痛发生比例、髋关节腔积液发生率均明显高于非ONFH组。.
结论: 目前国内SLE人群GC暴露后ONFH发生率仍较高（9.1%），其中短时间（前3个月）中高剂量（日均剂量≥15 mg/d）GC与ONFH密切关联，而重症SLE、低BMI、部分临床表型、aPLs阳性及继发动脉性高血压等因素可能与ONFH相关。.
Keywords: Systemic lupus erythematosus; clinical characteristics; glucocorticoid; osteonecrosis of the femoral head.